急诊冠状动脉介入治疗对ST段抬高心肌梗死患者跨室壁复极离散度的影响

摘要

Objective To probe the effects of primary PCI on transmural dispersion of repolarization(TDR) in patients with ST-elevated myocardial infarction. Methods 341 cases with STEMI were enrolled and divided into revascularized group (n = 212) and unrevascularized group (n =129)according to whether successful primary PCI was accomplished. Other cases who had no coronary heart disease constituted the control group (n = 36). TDR was quantified as Tpeak-Tend/RR1/2 ,which was nominated as Tp-e/c. The Tp-e/c values in control group, revascularized group and unrevascularized group were compared,and the influential factors of reduction of Tp-e/c(preand post-primary PCI) were detected. Results Although Tp-e/c in unrevascularized group was much higher than that in control group,there was no significant difference of Tp-e/c at time of admission,and on 2nd day or 3rd day (P ＞ 0.05). There was no marked difference of Tp-e/c reduction at the above-mentioned time-points despite different infarction-related arteries(IRA, P ＞0. 05). Reduction of Tp-e/c had independent positive correlation to total ST-descent, CK-MB and cTnI;and had independent negative correlation to LVEF or Killip classification. Conclusion Acute STEMI is characterized by significantly increased TDR which sustains a high level on the first 3 days at least. Primary PCI is benificial to reduction of TDR. Reduction of Tp-e/c is related to ST-descent,serum level of myocardial markers and left ventricular systolic function, while has nothing to do with different IRA.%目的 探讨急诊PCI对急性ST段抬高心肌梗死(STEMI)患者跨室壁复极离散度的影响.方法 选择STEMI患者341例,其中未能实现梗死相关冠状动脉再通者129例为非再通组.经急诊PCI再通者212例为再通组;另选择非冠心病者36例为对照组.以校正的T波顶点至终点时间(Tp-e/c,Tp-e/RR1/2)作为跨室壁复极离散度量化指标.比较正常者与STEMI患者、再通组与非再通组的Tp-e/c值;以及影响急诊PCI术后Tp-e/e下降幅度的相关因素.结果 非再通组Tp-e/c较对照组明显升高(P<0.01),且在入院即刻、第2、3天差异无统计学意义(P>0.05).再通组不同梗死相关冠状动脉在术后即刻、第2、3天Tp-e/c下降幅度差异无统计学意义(P>0.05).再通组Tp-e/c下降幅度与ST段回落程度、肌酸激酶同工酶、肌钙蛋白1、左心室舒张末内径呈独立正相关(r=0.381,r=0.238,r=0.201,r=0.147,P<0.01),与LVEF、Killip分级呈独立负相关(r=-0.198,P<0.01;r=-0.162,P<0.05).结论 急诊PCI能有效降低患者跨室壁复极离散度,该效果与不同梗死相关冠状动脉无关,而与ST回落程度、心肌标记物水平及左心室收缩功能有关.